What is a Carrier Block in Medical Billing

To understand the term Carrier Block one must have a good understanding of the CMS-1500 claim form.

What is the CMS-1500 claim form?

According to the Centers for Medicare and Medicaid Services (CMS) the “CMS-1500 form is the standard claim form used by a non-institutional provider or supplier to bill Medicare carriers and durable medical equipment regional carriers (DMERCs) when a provider qualifies for a waiver from the Administrative Simplification Compliance Act (ASCA) requirement for electronic submission of claims. It is also used for billing of some Medicaid State Agencies.” Even though the form is named as CMS-1500, it is not supplied by CMS. The form is designed and maintained by the National Uniform Claim Committee (NUCC). The form can be purchased from local printing companies in your area, office supply stores, and the U.S. Government Printing Office by contacting 1-866-512-1800.

Decoding the CMS-1500 to Identify Carrier Block

The CMS-1500 is a paper-based claim form. It is printed in “red ink” on white paper and scanned using Optical Character Recognition (OCR) technology. Since the form uses OCR technology is advisable not to submit a downloaded and printed copy of the form. It is because a printed copy is likely not to replicate the scale and OCR color of the original form. Therefore, always make sure to purchase the original form. The CMS-1500 is divided into 3 blocks and 33 fields/sections. The blocks are—Carrier Block, Patient and Insured Information, and Physician or Supplier Information.

Carrier Block

The term carrier block refers to space left on the CMS-1500 block to fill the details of the insurance company or insurance carrier. While giving the field-specific instructions, the NUCC mentions that “the carrier block is located in the upper center and right margin of the form” (http://www.nucc.org/images/stories/PDF/1500_claim_form_instruction_manual_2019_07-v7.pdf). The term ‘carrier’ refers to the payer, health plan, third-party administrator, or the other payer handling the health care insurance claim.

Filling the Carrier Block

Filling the carrier block can be quite tricky. However, if you know the correct format then your CMS-1500 form will be accepted without any issue (unless there is an error in the other two blocks). Write the name and address of the insurance payer or carrier in the white empty space provided at the upper center and right margin of the CMS-1500. The format to fill the carrier block is:

• First line: Name of the Insurance Company/Payer.
• Second Line: First line of the address.
• Third line: Second line of address (if required). However, if the second line does not exist in the address then leave this space empty.
• Fourth line: City, State (two characters), and Zip Code.

Example 1:

• XYZ Health Inc
• 123 W Main Street 106
• (………)
• Big City IL 60605

Example 2:

• XYZ Health Inc
• Suite 600
• 123 W Main Street 106
• Big City IL 60605

It is important to note that the name and address in the carrier block is free from any punctuation marks—i.e. do not use punctuations like comma, period and hyphen. The best way to file correctly filled CMS-1500 form is to outsource billing services from a clearinghouse.